Most Americans who have health insurance enjoy benefits through an employer-sponsored group plan. These plans typically have open enrollment periods and annual re-enrollment windows when benefits changes for the next year may be elected. However, most plans have criteria for midyear changes for certain qualified life changing events.
Qualifying Events
Each employer group and insurance carrier negotiate which events are eligible for a midyear benefits change, so there is no standard list of qualifying events. However, the events most frequently permitted include marriages, divorces, births and adoptions. In these instances, the primary insured person has 30 days to file a request for a benefits change, with appropriate documentation to prove that the event took place.
Procedure Changes
Coverage modifications for life changing events should be directed to the employer's benefits administrator, not to the insurance company. The employer will review the documentation to determine whether the employee meets eligibility criteria, and if so, will instruct the insurance company to modify that particular employee's benefit package. Usually, contacting the Human Resources department is a good first step to get the necessary forms and instructions. Employees will almost never directly deal with the insurance company for these types of changes, as per the insurer's contract with the employer.
Individual Coverage
A minority of people with insurance buy directly through an insurer, and do not receive health insurance from an employer. These people must contact the insurance company to request a benefits change; because there is no employer contract involved, it is generally easier to make changes, with less rigorous timing and documentation standards in place for most insurance carriers.
Tips
Record all correspondence about your request for a health-insurance modification because of a life-changing event. Because of the narrow window most people will have to make a change, it is essential to properly document a paper trail in case of discrepancies or errors within the process.
